Trainee Processing Checklist
Last Name, First Name (Please Print) SSN (no dashes) Date of Birth Place of Birth
Sex Race Height Weight Eye Color Hair Noticeable Scars or Tattoos
School: Palomar College Year: Semester: Instructor: Marilee Nebelsick-Tagg
Unit/Area: 5 East, SCI, 3W
Dialysis, 3ND palliative care unit Preceptor: Clinical Day(s): Monday
Process Instructions Student’s Initials
1. Complete and sign Clinical Trainee Appointment Letter.
2. Complete computer access form.
3. Visit the following website and complete items 1-2:
Declaration for Federal Employment Form (OF306) Complete forms and training. Submit
Application for Health Professions Trainees (VA 10-2850d) documents to your instructor.
4. Complete TMS Self-Enrollment for Non-Paid VA Staff
5. Read Nursing Orientation Packet (PDF via e-file)
6. VA Police – For Fingerprinting (Walk-In Process Only)
Provide VA Police with a government
Location: 1 East-Room 1593
issued ID at time of fingerprinting.
Hours: Monday 7am - 2pm & Tues to Friday from 6am - 3pm
I certify that I have received the Mandatory Training information and will comply with the contents thereof.
Trainee’s Signature Date
I certify that the trainee listed above has completed all applicable items on this list and has received a thorough orientation to
the best of my ability.
Instructor’s Signature Date
Date last reviewed 05/31/2012 fceafcbc-aed3-4ea1-af34-7bbd616a4ccd.doc